[Show abstract][Hide abstract] ABSTRACT: The need for expansion of health services provided in drug treatment programs has been widely discussed since the beginning of the HIV epidemic among drug users. Service expansion has focused on various types of services including medical services (eg, primary care) and harm-reduction services (eg, provision of sterile syringes).
A staff survey was conducted in 8 methadone maintenance clinics in the New York/New Jersey area to assess attitudes toward the provision of harm reduction and other services in methadone clinics, and the relationship of these attitudes to other variables.
A total of 114 staff members in 8 methadone maintenance clinics completed the survey.
The majority of staff was supportive of adding services, over 90% supported medical services, and the majority supported harm-reduction services such as syringe access and disposal services. Higher education and HIV knowledge levels were significant correlates of favorable attitudes toward service provision.
Support for providing harm-reduction services in methadone maintenance clinics was found. Enhancing knowledge of staff regarding various types of health services, and engaging them in how best to institute new services, should be undertaken when new services are planned.
Preview · Article · Dec 2011 · Journal of Addiction Medicine
[Show abstract][Hide abstract] ABSTRACT: Many barriers to the use of HIV medications have been identified. Research findings have also shown a gender disparity in HIV care behaviors. However, interaction effects of gender with the potential barriers to use of HIV medications among HIV-positive minority drug users remain under-studied. This study examined interaction effects of gender with potential moderating factors (i.e., individual and network characteristics) on the use of HIV medications. Analyses were based on 260 HIV-positive Puerto Rican heroin and cocaine users, recruited in New York (N=178) and Puerto Rico (N=82) in 1998-2003. HIV status was assessed using OraSure, and heroin or cocaine use was verified by urinalysis. All participants were tested and interviewed at baseline and six-month follow-up (183 males; 77 females). In predicting use of HIV medications at follow-up (HIVMEDF), use of HIV medications at baseline (HIVMED), individual characteristics (e.g., depression), network characteristics (e.g., having an intravenous drug user [IDU] sex partner), recruitment site, and interaction effects of these variables with gender, were examined in multiple logistic regression analysis. Use of HIV medications was low (29% at baseline; 40% at follow-up). HIVMED, recruitment site, gender, and depression had significant main effects on HIVMEDF. Depression also had a significant interaction effect with gender on HIVMEDF. Unlike men, women with depression were less likely than women without depression to use the medications. The findings indicate that gender-specific issues should be addressed by treatment programs for HIV-positive drug users, with particular efforts needed to enhance use of medications for depressed women.
[Show abstract][Hide abstract] ABSTRACT: Participating in civic activities has been found to be related to positive health outcomes.
This study examines associations between injection drug use health variables (sharing paraphernalia, using shooting galleries) and political/civic engagement (identifying with any political party, attention paid to politics and being registered to vote).
Participants (N = 162) were recruited at 6 New York City (NYC) methadone programs as part of an HIV intervention (86% male).
In the bivariate analysis, being registered to vote and political party identification were related to lower paraphernalia sharing; higher levels of attention paid to politics were associated with lower shooting gallery use. In the multivariate analysis, political party identification was associated with lower paraphernalia sharing and higher levels of attention paid to politics was related to lower shooting gallery use.
Findings suggest that maintaining connections with mainstream civic activities can be related to reduced health risks, including HIV risk behaviors.
This study contributes to understanding the relationships between involvement in civic/political participation and health, an area in which few studies have been conducted.
No preview · Article · Aug 2011 · The American Journal of Drug and Alcohol Abuse
[Show abstract][Hide abstract] ABSTRACT: Peer outreach models have been successful in addressing HIV risk behaviors of drug users. Patients in methadone maintenance treatment programs who were migrants from Puerto Rico and/or familiar with drug use there were trained to conduct HIV-related peer outreach. A group randomized design was implemented; patients in the Experimental (E) condition (n = 80) received training and conducted 12 weeks of outreach. Half of the patients completed the training and outreach. At follow-up, patients in the E condition who conducted outreach felt they were more helpful to their community, showed a trend for engaging in more vocational activities, and were more likely to talk with others about HIV, compared to those who did not conduct outreach and those in the Control condition (n = 78). Drug treatment patients who are migrants can be trained as peer outreach workers and short-term benefits were found. Longer term maintenance of benefits should be assessed.
Preview · Article · Apr 2011 · Journal of Immigrant and Minority Health
[Show abstract][Hide abstract] ABSTRACT: The importance of identifying differences in HIV risk between Hispanic subgroups is the focus of this article. Data are drawn from two New York?based HIV-related studies: among Puerto Rican drug users and among new immigrants from Central America, the Dominican Republic, and Mexico. Results indicated that intercultural individuals (i.e., those involved in both Puerto Rican and mainland cultures) were less risky in terms of injection- and sex-related risk behaviors and that geographic and other contextual factors, along with cultural norms, influence risk behaviors for immigrants. Both studies indicate the need to differentiate subgroup factors affecting HIV risk and prevention behaviors to develop appropriate and effective community-based interventions. The study's limitations are noted.
No preview · Article · Jan 2011 · Substance Use & Misuse
[Show abstract][Hide abstract] ABSTRACT: Hispanic patients were recruited from methadone maintenance treatment programs in 2005-2008 to be trained as peer outreach workers, targeting migrant drug users from Puerto Rico. Goals of the outreach focused on reducing HIV-related risk behaviors. A total of 80 peers were recruited from 4 clinics in New York and New Jersey. Following training, they conducted outreach in their communities for 12 weeks. This paper describes the challenges encountered during the recruitment, training, and outreach phases of the project, from the field perspective. Recommendations for future efforts in training drug treatment patients as outreach workers are provided.
No preview · Article · Apr 2010 · Substance Use & Misuse
[Show abstract][Hide abstract] ABSTRACT: From 2005 to 2008, the Bienvenidos Project trained Puerto Rican patients of New York City and New Jersey Methadone Maintenance Treatment Programs to conduct peer-based community outreach to migrant Puerto Rican drug users to reduce migrants' HIV risk behaviors. Ethnographic research, including focus groups, individual interviews, and observations, was conducted with a subset of the patients trained as peers (n = 49; 67% male; mean age 40.3 years) to evaluate the self-perceived effects of the intervention. Results of the ethnographic component of this study are summarized. The role of ethnographic methods in implementing and evaluating this kind of intervention is also discussed.
Full-text · Article · Feb 2010 · Substance Use & Misuse
[Show abstract][Hide abstract] ABSTRACT: This study examined factors that mediate and moderate the relationship between gender and utilization of mental health and medical services in the past year among Puerto Rican drug users (308 females; 892 males) recruited in New York City. Experience of sexual or physical abuse, injection drug use, relationship variables (e.g., having a sexual partner who is an injection drug user), and serious or chronic mental/medical conditions were used as potential mediators and moderators. Both sexual and physical abuse mediated gender effects on use of mental health services. Having chronic medical problems mediated the relationship between gender and utilization of medical and mental health services. Significant interaction effects of gender by depression, physical abuse, and HIV sero-status on utilization of medical services were found. Health (particularly mental health) care was under-utilized by both women and men, despite high rates of depression and chronic medical conditions. The finding of under-use of medical services by HIV-positive drug users (particularly by HIV-positive women) indicates a need for further efforts to engage all HIV-positive persons in care. The findings also indicate an on-going need for mental and other health services for drug users who have been victims of abuse.
Preview · Article · May 2009 · Drug and alcohol dependence
[Show abstract][Hide abstract] ABSTRACT: Biculturality refers to two independent processes of acculturation, one to the host society's culture and another to the culture of origin. This study examined the relationship between biculturality and HIV-related risk behaviors in a sample of injecting and noninjecting Puerto Rican drug users (N = 259), recruited in New York City in 2005-2006. Biculturality was measured by two scales: involvement in (i) American culture (AMBIC) and (ii) Puerto Rican culture Biculturality (PRBIC). The majority (78%) of the participants were males, with a mean age of 42 years. About half were born in Puerto Rico, and the average length of stay in the United States was 26 years. In multiple logistic-regression analysis, AMBIC was significantly related to lower injection risk after controlling for other factors including gender, age, and MMTP enrollment, while PRBIC was a significant predictor of higher sex risk. Involvement in the host culture and the culture of origin differed in their relationship to risk behaviors, indicating that incorporating assessments of biculturality may be useful in assessing and addressing migrants' behaviors, including HIV-risk behaviors. The study's limitations have been noted.
No preview · Article · Feb 2009 · Substance Use & Misuse
[Show abstract][Hide abstract] ABSTRACT: This study examined gender-specific effects of social bonds, network characteristics, and other factors on drug treatment enrollment among Puerto Rican drug users.
Participants (425 women; 1,374 men) were recruited in New York and Puerto Rico in 1998-2003.
Gender differences were found: education (< high school/GED) and having a sex partner who is an injection drug user (IDU) were significantly related to current enrollment in drug treatment (EDT) for women; for men, having an IDU friend (negatively) had a main effect on EDT, and having an IDU friend also had a significant interaction effect with their own injection drug use on EDT. For both women and men, recruitment site (New York), having health insurance, and prior methadone treatment were significant predictors of EDT.
The findings may be useful in developing gender-differentiated drug counseling and treatment efforts that engage women's sex partners and men's friendship networks to build support for drug treatment.
No preview · Article · Feb 2009 · The American Journal of Drug and Alcohol Abuse
[Show abstract][Hide abstract] ABSTRACT: Puerto Rican drug users recruited in NY who previously used drugs in Puerto Rico (PR) have been found to have higher HIV injection and sex-related risk behaviors than those who had not used in PR. This study examined predictors of risk among migrant Puerto Rican drug users. (For the purpose of this paper, the term "migrant" was used to designate Puerto Rican drug users who had used drugs in Puerto Rico and were recruited in New York or New Jersey).
A total of 290 drug users who had previously used drugs in PR were recruited in NY and New Jersey and interviewed regarding drug use history and HIV risk behaviors.
Participants engaged in high risk behaviors, e.g., 39% shared injection paraphernalia and 62% reported unprotected sex. Multivariate analyses found that predictors of injection-related risk included being born in PR and purchasing drugs jointly with other drug users; predictors of sex-related risk included younger age and homelessness.
Addressing risk reduction among those drug users who were born in Puerto Rico and are younger or homeless was indicated, and efforts to reach those at highest risk through NEPs was recommended.
No preview · Article · Jan 2009 · Journal of Immigrant and Minority Health
[Show abstract][Hide abstract] ABSTRACT: Objectives: This study describes the criminal justice histories of drug users recruited in NYC and NJ and their HIV-related injection risk while incarcerated.
Methods: Participants (n=391) were recruited between 2005-2007 as part of an HIV-related peer intervention. Subjects were methadone patients and current drug users recruited through participant referrals and street-based outreach. Current drug use status for opiates and cocaine was confirmed through urinalysis.
Results: 76% of the sample was male and their mean age was 42. Overall, 79% tested positive for opiates or cocaine and 41% reported injecting drugs in the past 30 days. Participants had an average of 4.2 lifetime drug-related arrests and 52% of the last arrests were for a drug sale or possession charge. Five percent of the sample was currently on parole, 4% on probation and 5% awaiting trial or sentence. Of those ever incarcerated, 29% reported using non-injection drugs and 7% injected drugs while in detention. Among the latter, 57% shared syringes or injection related equipment while incarcerated.
Discussion: A substantial proportion of drug users continue to use drugs while incarcerated. Though they are a relatively small subgroup of users in detention, persons who inject drugs while incarcerated report risk behaviors that put them at very high risk of HIV and HCV infection, indicating the need for risk reduction services in detention facilities.
[Show abstract][Hide abstract] ABSTRACT: Background: Drug users have evidenced gender differences in healthcare utilization. However, the factors contributing to these differences remain under-studied. This study examined factors mediating the relationship between gender and healthcare utilization (HCU).
Methods: 1,799 Puerto Rican heroin and/or cocaine users (1,374 males; 425 females) were recruited in NYC and Puerto Rico in 1998-2003. HCU (prior 12 months) was measured by: 1) use of mental health services; and 2) use of medical services. Ever been abused (sexual and physical), depression, having chronic medical problems, and having an IDU sex partner were used as potential mediators. Correlations and logistic regression analyses were examined for mediation tests.
Results: Mean age 42. Gender (male=1; female=2) was significantly (p<.05) related to sexual and physical abuse (r=.42; r=.41, respectively), depression (r=.15), having chronic medical problems (r=.12), and having an IDU sex partner (r=.14). Gender was also significantly related to use of mental health services (OR=1.66, p<.001) and use of medical services (OR=1.51, p<.001). A series of mediation tests found that both sexual abuse and physical abuse mediated gender effects on use of mental health services (when abuse was added to the model, the gender effects became not significant [p=ns]). Depression and having chronic medical problems partially mediated the relationship between gender and use of mental health services. Sexual and physical abuse also partially mediated the relationship between gender and use of medical services. No other mediation effects were found.
Discussion: Sexual and physical abuse experience mediated gender-HCU relationships, indicating the importance of addressing abuse experiences in this population. The findings also indicate an on-going need for mental and other health services for drug users who were victims of abuse.
[Show abstract][Hide abstract] ABSTRACT: Objective: This study examined differences in network characteristics between those in MMTPs not using heroin and/or cocaine (H/C) and current H/C users.
Methods: Hispanic (mostly Puerto Rican) H/C users (N=387) were recruited in 2005-2007 in NYC and New Jersey, using multiple recruitment methods. Urinalysis for H/C was conducted at recruitment (negative, N=83; positive, N=304). Participants were asked to name up to 5 people for each of the 4 following areas: friends; people with whom they injected drugs (IDU) or used non-injected H/C (NIDU); and sex partners (SP) (during prior 3 months).
Results: 78% male; mean age=41.6; 42% currently injected drugs. Participants named at least 1 person as: friends (60%), IDUs (26%), NIDUs (33%), and SP (69%). Total number of network members ranged from 0 to 13 (none, 12%; 1-2, 43%; 3-4, 27%; and 5-13, 17%). On average, 87% of their network members were Hispanics. More drug use members were named among current drug users than among former users (IDUs: 31% vs. 8%, p<.001; NIDUs: 38% vs. 14%, p<.001). No significant difference was found in SP (70% vs. 65%). Of those who had any network member, for both groups, on average, 17% named family members (p=ns). Of those who had an IDU network member, about half named the same individual in both friend and IDU networks.
Discussions: The findings evidence the importance of network members in drug use behaviors, suggesting that HIV prevention/education programs for users in or out of drug treatment also include network members.
[Show abstract][Hide abstract] ABSTRACT: Reducing sex risk behaviors among high-risk injection drug users (IDUs) and crack smokers is a continuing challenge for HIV prevention. Based on a longitudinal study of sexually active Puerto Rican IDUs and crack smokers in New York (n = 573) and Puerto Rico (n = 264), baseline predictors of changes in sex risk (number of unprotected sex acts) at 6- and 36-month follow-up interviews were examined. In New York, predictors of higher sex risk were being younger, having primary partners, having more other sex partners, never exchanging sex, having lower self-efficacy for reducing sex risk behaviors and being HIV-negative, and these predictors were significant at both postbaseline periods. In Puerto Rico, short-term predictors included being male, having primary partners, never exchanging sex, lower sex risk norms and lower self-efficacy. However, only having primary partners was significant in longer-term behaviors. Results indicated the need for enhancing self-efficacy and for developing risk reduction strategies related to community differences.
Preview · Article · Sep 2008 · AIDS Education and Prevention
[Show abstract][Hide abstract] ABSTRACT: Gender differences were examined in health status and HIV care among HIV-infected minority drug users. More women than men reported having HIV-related symptoms and other health conditions, such as asthma and allergies. Hepatitis B or C was more often reported by men. As compared to men, women delayed HIV care and fewer attended HIV support groups. Delayed entry into HIV treatment was also significantly related to being Hispanic and being diagnosed with HIV in the pre-HAART era. No significant gender difference was found in current use of HIV medications. Use of HIV medications was significantly related to being married, no history of childhood sexual abuse, enrollment in an HIV clinic and attending HIV support groups. The findings demonstrate the importance of family and social support for HIV-positive drug users and also suggest a need for special attention to those who have childhood sexual abuse experience.
[Show abstract][Hide abstract] ABSTRACT: This study examines the influence of peer norms on sharing of injection paraphernalia (e.g., indirect sharing behaviors, including sharing of cookers, cotton, rinse water and back/front loading) among Puerto Rican injection drug users (IDUs) in Bayamón, Puerto Rico, and East Harlem, New York City. Data were collected from 873 Puerto Rican IDUs recruited in the two locations by outreach workers. Multiple logistic regression was conducted using sociodemographic and other control variables (e.g., education, frequency of injection, pooling money to buy drugs, use of needle exchange program, injection in galleries and syringe sharing behaviors) and two types of norms related to sharing of injection paraphernalia-encouraging risk norms (what others approve) and objecting to risk norms (what others disapprove). One type of norms, encouraging or approval norms, was associated with indirect sharing in New York but not in Puerto Rico. Pooling money to buy drugs, use of shooting galleries and syringe sharing was associated with indirect sharing in both locations. Prevention programs to reduce indirect sharing behaviors should take into consideration different types of risk norms in order to reduce indirect sharing risk behaviors.
No preview · Article · Jul 2008 · AIDS Education and Prevention
[Show abstract][Hide abstract] ABSTRACT: Background: Biculturalism refers to two independent processes of acculturation, one to the host society's culture and another to the culture of origin. The relationship between biculturalism and HIV risk behaviors was examined in a sample of Puerto Rican drug users (PRDUs). Methods: 261 PRDUs were recruited in NYC in 2005-2006. Biculturalism was measured by two scales: involvement in (i) American culture (AMBIC) and (ii) Puerto Rican culture (PRBIC). The HIV risk behaviors (prior 30 days) included injection drug use and having unprotected sex. Other variables examined were: socio-demographics, norms and self-efficacy regarding HIV risk. Results: 78% males; mean age 42; 53% born in PR; lived 26 years (mean) in the US; 42% currently injected drugs; and 72% enrolled in methadone treatment. AMBIC and PRBIC were not significantly related (r=-.07). AMBIC was significantly (p<.05) associated with age (older), gender (female), years living in the US, and negatively related to spending adolescence in PR, injection drug use, injection frequency, and heroin/cocaine use. PRBIC was significantly related to being born in PR, fewer years living in the US, spending adolescence in PR, and riskier norms for sex. In multiple logistic regression analysis, AMBIC remained as a significant factor in predicting lower injection risk, and PRBIC was a significant factor for higher sex risk. Conclusion/Discussion: Acculturation to the host culture and culture of origin differed in their relationship to risk, indicating that incorporating assessments of biculturality may be useful in assessing and addressing HIV risk behaviors.
[Show abstract][Hide abstract] ABSTRACT: Background: Drug users are at high risk of developing many debilitating and potentially life threatening health conditions. This study presents data on the prevalence of eight health conditions among drug users who are both in and out of drug treatment.
Methods: Participants (n=109) were recruited from 4 NYC methadone clinics (2 in the Bronx and 2 in Manhattan) and from the neighborhoods where the clinics are located. Participants were recruited as part of a study of migrant Puerto Rican drug users, and criteria for inclusion included having used heroin or cocaine in Puerto Rico or having a friend/family member who used there.
Results: 66% of the sample was male; mean age was 41.5 and 79% were in drug treatment. Overall, 84% reported having at least one health condition, including 29% who reported 1 and 55% who reported 2 or more conditions. In descending order, the most prevalent conditions were: mental health (51%), respiratory (43%), hepatitis C (43%), heart problems (25%), diabetes (16%), HIV/AIDS (8%), ulcers (6%), and emphysema (5%). The most common co-occurring conditions among the total sample were mental health problems and the following conditions: HCV (24%), heart problems (18%) and diabetes (13%).
Conclusions: Drug users suffer from a range of chronic health conditions, particularly mental health, respiratory and hepatitis C. Drug treatment programs and interventions for drug users can address these issues by referring patients to medical services and providing services on-site, such as education on how to manage these conditions.
[Show abstract][Hide abstract] ABSTRACT: Background: Research has shown that there is a need to reduce HIV risk behavior among drug users who used drugs in Puerto Rico (PR), and that peers are highly effective in conducting outreach to users. Methods: 81 Puerto Rican patients were recruited in 4 methadone clinics in NY. Criteria included: bilingual and previously used heroin or cocaine in PR (or had family/friends who did). Clients from 2 clinics (n=40) were randomly assigned to be trained and to conduct peer outreach (for 12 weeks); 2 clinics (n=41) were comparisons. Data were collected at baseline (T1), after outreach ended (T2), and 6 months later (T3). Results: Of those assigned to Outreach condition, 26 (65%) completed training and conducted outreach. Analyses compared them with trends for: those who did not complete the outreach program, and the comparisons. At T2- 100% of those who completed training were still in MMTP (compared to 80% and 89% of the two other groups), and were more likely to report talking with others about HIV (e.g., 48% talked with drug users vs 30% and 31%); they were also more likely to have engaged in vocational activities (16% vs 0% and 6%). At T3, these differences were not sustained. Qualitative interviews with peers indicated that while the intervention was beneficial, participants became discouraged after the project ended. Conclusions: Training MMTP clients as outreach workers is a promising approach to enhancing their vocational progress. However, methods to provide on-going support, within the clinic setting, are needed to sustain gains made.